There’s no such thing as a free lunch… or a free shot

Breakfast with Bwana

By Anil Madan

The op-ed in The Washington Post appeared on January 3, suggesting that we skip the second shot or “chaser” of the Covid-19 mRNA vaccine until more supplies become available. Specifically, the authors Robert M. Wachter & Ashish K Jha wrote: “It’s time to change the plan; namely, we should give people a single vaccination now and defer their second shot until more doses of vaccine become available.”

Taking part in a Covid-19 vaccine trial, funded by Operation Warp Speed, in Hollywood, Fla., this month. Photo – Getty Images

Wachter is chair of the department of medicine at the University of California at San Francisco. Ashish K. Jha is dean of the Brown University School of Public Health. High positions, to be sure. But should we take this advice seriously? It appears that President-elect Biden has decided to release all available supplies of Pfizer and Moderna vaccines and not hold back enough for the “chaser” shot that has been shown to have 94% and 95% efficacy.

I’ve thought for a long time that Ashish Jha loves to be on TV. He seems to get a little glow on his face – almost as if he’s been nominated Rudolph the Red-nosed Reindeer.

Well, I wonder if Dr Fauci appreciates that Dr Jha may be trying to usurp his position as the Dean of Vaccines at the head of the Covid Sleigh. Oh, deer!

Dr Jha is not an epidemiologist or virologist. He is described as an internist and academician in a Twitter profile. He has written articles on such varied subjects as Use of electronic health records in US hospitals, Health care spending in the United States and other high-income countries, Clinical supply shortages (this one about ventilators and PPE), Patients’ perception of hospital care in the U.S., and so on. You get the idea. For all his appearances on TV as an expert, he has no expertise in virology or immunology.  Dr Wachter coined the term “Hospitalist” and is often considered the father of the hospitalist field according to a publicity blurb on the UCSF medicine website.

The problem that I see with all this rambling from so-called experts is that they really don’t know what they are talking about, but this doesn’t stop them. Pfizer and Moderna must have some reason for requiring two shots even if the original reason was nothing more than a modern adaptation of The Shampoo Algorithm – Lather, Rinse, Repeat. (I have read that Benjamin Cheever’s novel The Plagiarist, features a marketing executive who comes up with that direction to increase the usage and hence resultant sales of shampoo but I’ve also read that this actually happened, perhaps at the facilities of the maker of Breck shampoo).

But don’t take my word on this. Here is what Dr Lewis Jacobson, Professor Emeritus of Biological Sciences University of Pittsburgh wrote:

“The problem now is that if we don’t give the second shot, the primary response fades in (usually) days to weeks. In the recent Pfizer and Moderna clinical trials, the second shot was given 3-4 weeks after the first, so any data on efficacy between shots tell us only efficacy at the narrow peak of the first wave of immunity. We know almost nothing about what will happen if people don’t get the second shot. They may remain effectively immune for years (like chicken pox or tetanus), or they may become susceptible again in weeks. It probably won’t be fully effective immunity.

“And that brings us to the behavioural hazard. People who have had their one (recommended!) shot will now behave as if they’re immune, and will be at higher risk for infection and transmission. We can’t fix this by telling them their first shot is ineffective, because that will sabotage the entire vaccination push.”

Anyhow, a more sensible discussion of vaccination logistics is that we will likely have to find a way to administer the shots outside a hospital setting as hospital workers at all levels, are stretched thin and stressed.

Then there are the logistics involved. You have to maintain social distancing of six feet between the targets (okay, okay, I know we shouldn’t call people getting shots “targets” – I wonder if Target, the Department Store calls its customers targets?). That seems somehow illogical because once you’ve been targeted, you start developing immunity. But, of course, it takes time.

Two doses more than doubles the logistical challenges of administering the vaccines. Photo – AP

That’s not all. You also have to keep each target who has been “acquired” i.e. jabbed, hanging around for fifteen to thirty minutes while waiting to see if there is a possible anaphylactic or other reaction. Meanwhile, the suckers… er targets… are spewing aerosolized breath even if only under their masks.

That’s a formidable challenge. It’s going to take a long, long time to vaccinate everyone.

Let us keep in mind the foundation on which these new approaches rest. Dr Anthony Fauci, who has been recruited as a key adviser to the Biden Administration that will take charge soon, asserted that there’s no plan to abandon the two-shot regimen. The Biden team is “not talking about withholding and not giving the second dose,” he said. “They are completely committed to giving the second dose on time. They feel that the importance of getting as many people as possible is worth the risk.”

Media sources, including National Public Radio report that the Biden team is hopeful companies will be able to manufacture more doses quickly: “We have faith that the manufacturers can produce enough vaccines to ensure people can get their second doses in a timely manner, while also getting more people their first dose,” Biden’s incoming press secretary Jen Psaki said in a recent briefing. “The president-elect has said he will use the Defense Production Act as needed to help produce materials and whatever else is needed to ensure supply.”

So, the Biden administration thinks it’s worth taking the risk according to Dr Fauci. I suppose if you have the blessing of the nation’s top epidemiologist on matters of risk, you can justify anything.

What’s surprising to me is that they didn’t make an epi-Pen like device for self-vaccination and sell it along with a second epi-Pen (the real kind, the price of which Senator Joe Manchin’s daughter raised to over $600 or so) in case of an allergic reaction.

Remember that these are the same people who told us that a three-week lockdown would stop the spread of the virus.

Free enterprise. Just tells you there’s no such thing as a free lunch or a free shot.



Link to The Washington Post op-ed:

* Published in print edition on 19 January 2021

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